PRKAR1A in the development of cardiac myxoma

A study of 110 cases including isolated and syndromic tumors

Joseph Maleszewski, Brandon Larsen, Nefize Sertac Kip, Mathieu C. Castonguay, William D. Edwards, J. Aidan Carney, Benjamin R. Kipp

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Cardiac myxoma usually occurs as a solitary mass, but occasionally develops as part of a familial syndrome, the Carney complex (CNC). Two thirds of CNC-associated cardiac myxomas exhibit mutations in PRKAR1A. PRKAR1A mutations occur in both familial and sporadic forms of CNC but have not been described in isolated (nonsyndromic) cardiac myxomas. A total of 127 consecutive cardiac myxomas surgically resected at Mayo Clinic (1993 to 2011) from 110 individuals were studied. Clinical, radiologic, and pathologic findings were reviewed. Of these, 103 patients had isolated cardiac myxomas, and 7 patients had the tumor as a component of CNC. Age and sex distributions were different for CNC (mean 26 y, range 14 to 44 y, 71% female) and non-CNC (mean 62 y, range 18 to 92 y, 63% female) patients. PRKAR1A immunohistochemical analysis (IHC) was performed, and myxoma cell reactivity was graded semiquantitatively. Bidirectional Sanger sequencing was performed in 3 CNC patients and 29 non-CNC patients, to test for the presence of mutations in all coding regions and intron/exon boundaries of the PRKAR1A gene. IHC staining showed that all 7 CNC cases lacked PRKAR1A antigenicity and that 33 (32%) isolated cardiac myxomas were similarly nonreactive. Of tumors subjected to sequencing analysis, 2 (67%) CNC myxomas and 9 (31%) non-CNC myxomas had pathogenic PRKAR1A mutations. No germline mutations were found in 4 non-CNC cases tested. PRKAR1A appears to play a role in the development of both syndromic and nonsyndromic cardiac myxomas. Routine IHC evaluation of cardiac myxomas for PRKAR1A expression may be useful in excluding a diagnosis of CNC.

Original languageEnglish (US)
Pages (from-to)1079-1087
Number of pages9
JournalAmerican Journal of Surgical Pathology
Volume38
Issue number8
DOIs
StatePublished - Jan 1 2014

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Carney Complex
Myxoma
Neoplasms
Mutation
Sex Distribution
Germ-Line Mutation
Age Distribution
Introns
Exons
Staining and Labeling

Keywords

  • cardiac tumors
  • Carney syndrome
  • molecular diagnostics

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

Cite this

PRKAR1A in the development of cardiac myxoma : A study of 110 cases including isolated and syndromic tumors. / Maleszewski, Joseph; Larsen, Brandon; Kip, Nefize Sertac; Castonguay, Mathieu C.; Edwards, William D.; Carney, J. Aidan; Kipp, Benjamin R.

In: American Journal of Surgical Pathology, Vol. 38, No. 8, 01.01.2014, p. 1079-1087.

Research output: Contribution to journalArticle

Maleszewski, Joseph ; Larsen, Brandon ; Kip, Nefize Sertac ; Castonguay, Mathieu C. ; Edwards, William D. ; Carney, J. Aidan ; Kipp, Benjamin R. / PRKAR1A in the development of cardiac myxoma : A study of 110 cases including isolated and syndromic tumors. In: American Journal of Surgical Pathology. 2014 ; Vol. 38, No. 8. pp. 1079-1087.
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